Doctors Lounge - Pulmonology Answers

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I am now 36 years old, and when i was younger from about age 13-26 I used cocaine pretty heavy and ODed on it once...had a MI etc, now ive turned my life around and all and exercise regularly, eat fairly healthy, and all, but my friend said that i probably have lasting heart damage. is that true? And what should i do about it? Im really kinda scared now, i have a lot of family stress going on and have been having regular heartburn, but i think thats all it is. should i be scared and have i ruined my heart for life?

Hi,With the lifetime use of cocaine rising, adverse reactions to cocaine use have resulted in a situation wherein it has become necessary to consider cocaine related complications in the differential diagnosis of various disorders, particularly ischemic events in young adults.

Cigarette smoking causes vasoconstriction of the coronary arteries through an α-adrenergic mechanism similar to that of cocaine. Several recent studies have shown that the deleterious effects of cocaine on myocardial oxygen supply and demand are exacerbated substantially by concomitant cigarette smoking. This combination markedly increases the myocardial oxygen demands, while simultaneously decreasing the diameter of diseased segments of the coronary arteries.This predisposes to myocardial ischemia.

A recent survey has suggested that 9 million people in the United States abuse ethanol and cocaine simultaneously. Among those with a history of co-abuse of multiple substances who present at the emergency departments, the co-abuse of cocaine and ethanol is the most common. It is perhaps the second most common combination in patients who die of substance abuse, accounting for more than 1000 deaths per year(The most frequent multiple-drug deaths involve various combinations of opiates/opioids, cocaine, and alcohol). The co-abuse of cocaine and ethanol appears to be associated with higher rates of disability and death than either agent alone. Persons who co-abuse cocaine and ethanol produce cocaethylene, a metabolite synthesized by hepatic-transesterification. Similar to cocaine, it blocks the reuptake of dopamine at the synaptic cleft, thereby possibly potentiating the systemic toxic effects of cocaine. At autopsies, cocaethylene is often detected in persons who died of cocaine and ethanol toxicity.

During a myocardial infarction,some of the myocardium gets infarcted and that damage is permanent.The other complications such as cardiomyopathy may recover to an unpredictable extent following complete abstinence from the abused substance.Best wishes!